Purpose: :
To report the successful use of verteporfin photodynamic therapy(PDT) combined with triamcinolone acetonide after an unsuccessfultrial of intravitreal bevacizumab in treating cystoid macularedema (CME) and Coats-type retinitis pigmentosa (RP).

Methods: :
Observational case report; A 15 year old female received a seriesof two intravitreal bevacizumab injections for CME associatedwith Coats-type RP without effect. Subsequent treatment withverteporfin PDT to the peripheral Coats lesion along with intravitrealtriamcinolone was successful.

Results: :
Initial treatment was started with intravitreal bevacizumabin the right eye. A series of two bevacizumab injections wasperformed without improvement of macular edema on OCT or resolutionof the Coats lesion. At this time, standard-dose verteporfinPDT was performed to the Coats lesion along with an injectionof intravitreal triamcinolone acetonide. There was a promptresponse to this intervention with OCT showing a reduction incentral foveal thickness to 165 microns, a decrease of 428 microns,and fibrosis of the peripheral Coats lesion. Intravitreal triamcinolonewas then performed to the left eye with a resolution of edemafrom 546 microns to 188 microns, six weeks later. Visual acuitystabilized at 20/50 OD and 20/60 OS with the patient notinga significant subjective improvement in visual function.

Conclusions: :
There are no reported cases of Coats-type RP being treated withanti-angiogenic agents. Theoretically, bevacizumab has the potentialto treat both the Coats reaction as well as the CME due to itsanti-permeability and anti-angiogenic actions. Based on thisfacts, a trial of intravitreal bevacizumab was initiated inthis patient who had both macular edema and peripheral Coats-reaction.This treatment was found to be ineffective for treatment ofCME or the Coats response in our patient, and we next triedverteporfin PDT in combination with intravitreal triamcinolone.This approach proved very effective. The CME resolved for manymonths and the regressed peripheral Coats lesion has been stablefor over a year. There is very little published experience regardingsuccessful treatment of CME in RP with anti-VEGF agents. Ourexperience in this case report confirmed reported unsuccessfulresults of anti-VEGF therapy for CME in RP. Although other approachessuch as direct laser photocoagulation to the Coats lesion andoral or topical carbonic anhydrase inhibitors for CME may havealso been successful for the management of this patient, thecombination of verteporfin photodynamic therapy and intravitrealtriamcinolone appears to be a safe and effective means to treatRP with Coats reaction and CME.